Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2014
Median-evoked somatosensory potentials in severe brain injury: does initial loss of cortical potentials exclude recovery?
In patients with severe brain injury (SBI) median-evoked somatosensory potentials (M-SSEP) serve as a prognostic tool. Bilateral loss of cortical responses (BLCR) is usually thought to be a reliable marker of poor prognosis. Prognostic accuracy to predict a poor outcome depends on the cause of coma and is best in hypoxic-ischemic encephalopathy (HIE) reaching almost 100% which is in contrast to patients with other etiologies of coma, especially traumatic brain injury (TBI). Only little evidence exists on the possibility of electrophysiological recovery of BLCR in repeated or serial SSEP-examinations and detailed functional outcome in these cases. ⋯ Electrophysiological recovery from primarily BLCR seems possible and is accompanied by good functional outcome in a relevant number of patients. Thus caution is warranted in predicting a poor prognosis based predominantly on SSEP, especially in patients with TBI. Focusing SSEP-examination on the early days after severe brain injury and performing only one examination in the case of BLCR may lead to systematic underestimation of the possibility of recovery.
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Clin Neurol Neurosurg · Aug 2014
Functional magnetic resonance imaging of motor and language for preoperative planning of neurosurgical procedures adjacent to functional areas.
Functional magnetic resonance imaging (fMRI) for motor and language mapping is used for presurgical planning. This study aimed to evaluate the value of fMRI in clinical routine for preoperative planning of brain surgery adjacent to functional brain areas. ⋯ fMRI for clinical routine is a reliable and rapid method for identification of functional brain areas prior to brain surgery adjacent to functional areas. This method allows direct monitoring of the data quality and visualization without being time consuming. Knowledge about the relation of functional areas to the brain lesions improves the preoperative planning, the operation strategy and decision making with patients.
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Clin Neurol Neurosurg · Aug 2014
ReviewThe relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage.
Sodium dysregulation in the course after aneurysmal subarachnoid hemorrhage (aSAH) has been identified as one contributor to adverse clinical outcome. However, the correlation of acute dysnatremia and early brain injury (EBI) remains unclear. We investigated the early course and prognostic relevance of changes in serum sodium concentrations and its relation to EBI after aSAH. ⋯ The occurrence of hypernatremia within 56h after aSAH was shown to be an independent predictor for poor neurological outcome. Early serum sodium levels after aSAH can be considered as surrogate markers to predict outcome after aSAH irrespective to the occurrence of DCI. However, prospective studies are necessary to validate this concept.
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Clin Neurol Neurosurg · Aug 2014
ReviewChemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol.
Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. ⋯ The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24h after the demonstration of a stable intracranial injury by computed tomography (CT).
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Clin Neurol Neurosurg · Aug 2014
Longitudinal incidence and concurrence rates for traumatic brain injury and spine injury - a twenty year analysis.
The reported incidence of concurrent traumatic brain (TBI) and spine or spinal cord injuries (SCI) is poorly defined, with widely variable literature rates from 16 to 74%. ⋯ A retrospective review of the NIS demonstrates a rising trend in the incidence of concurrent TBI and SCI. More investigative work is necessary to examine causative factors for this trend.